Assessment of congenital coronary artery fistulas by transesophageal color Doppler echocardiography

PURPOSE: Coronary angiography is the gold standard for imaging the coronary tree, but the relation of coronary artery fistulas to other structures, and their origin and course, may not be apparent. We evaluated the ability of multiplane color Doppler transesophageal echocardiography to identify coronary fistulas. PATIENTS AND METHODS: Twenty-one patients with angiographically confirmed coronary artery fistulas were investigated by transesophageal echocardiography in four Italian hospitals between January 1997 and May 2001. RESULTS: Transesophageal echocardiography correctly diagnosed fistulous connection in all 21 patients. This included 6 patients with connections from the left circumflex artery (into the right chambers of the heart in 5 patients, and into the left ventricle in 1 patient), 10 patients with a fistula arising from the left anterior descending artery or left main coronary artery (with drainage into the right ventricle or main pulmonary artery), and 5 patients with a fistula from the right coronary artery (with drainage sites in the lateral aspect of the right ventricle, the low posterior right atrium, or the superior vena cava). In 4 of the 21 patients, angiography did not identify the precise site of a fistula into the coronary sinus or right ventricle. CONCLUSION: Color Doppler transesophageal echocardiography is useful in the diagnosis and in the precise localization of coronary artery fistulas

Assessment of ascending aorta distensibility after successful coarctation repair by strain Doppler echocardiography

BACKGROUND: Increased arterial stiffness may participate in the genesis of hypertension and increase of left ventricular (LV) mass after surgical correction of coarctation of the aorta. The purpose of the current study was to assess the aortic elastic properties using Doppler tissue imaging and strain rate imaging in patients after coarctoplasty. METHODS: Echocardiography with Doppler tissue/strain rate imaging capabilities was performed in 26 adult normotensive patients who had successful repair of coarctation of the aorta in infancy and in 24 control subjects. Transesophageal aortic transverse sections were imaged at the level of the proximal and distal segments to the repair site. Doppler tissue imaging wall velocities during systole (S(w)), early relaxation (E(w)), and atrial systole (A(w)) and peak systolic strain (ps epsilon) were measured in both groups. Transthoracic ascending aorta (AAo) measurements were also obtained. RESULTS: In the patients with coarctoplasty, S(w) velocities and ps epsilon were significantly decreased in the proximal segments compared with control subjects. Both peak systolic blood pressure after exercise (P < .001) and pulse pressure after exercise (P < .001) were directly related to AAo wall strain. LV annular early diastolic velocity was significantly reduced compared with control subjects in patients with decreased AAo wall strain and exercise-induced hypertension (P < .001) and related to AAo wall velocity (P < .005) and strain (P < .001). In multiple linear regression analysis, only weight, study group, and AAo wall strain were correlated to LV mass index. CONCLUSIONS: Patients with coarctation of the aorta have reduced proximal aortic wall velocities and strain and increased stiffness even after successful repair. This amplifies stress-induced hypertension and increases LV burden

Gestión del conocimiento: perspectiva multidisciplinaria. Volumen 12

El libro “Gestión del Conocimiento. Perspectiva Multidisciplinaria”, Volumen 12, de la Colección Unión Global, es resultado de investigaciones. Los capítulos del libro, son resultados de investigaciones desarrolladas por sus autores. El libro cuenta con el apoyo de los grupos de investigación: Universidad Sur del Lago “Jesús María Semprúm” (UNESUR), Zulia – Venezuela; Universidad Politécnica Territorial de Falcón Alonso Gamero (UPTAG), Falcón – Venezuela; Universidad Politécnica Territorial de Mérida Kleber Ramírez (UPTM), Mérida – Venezuela; Universidad Guanajuato (UG) - Campus Celaya - Salvatierra - Cuerpo Académico de Biodesarrollo y Bioeconomía en las Organizaciones y Políticas Públicas (C.A.B.B.O.P.P), Guanajuato – México; Centro de Altos Estudios de Venezuela (CEALEVE), Zulia – Venezuela, Centro Integral de Formación Educativa Especializada del Sur (CIFE - SUR) - Zulia - Venezuela, Centro de Investigaciones Internacionales SAS (CIN), Antioquia - Colombia.y diferentes grupos de investigación del ámbito nacional e internacional que hoy se unen para estrechar vínculos investigativos, para que sus aportes científicos formen parte de los libros que se publiquen en formatos digital e impreso

Assessment of biventricular and vascular function using three-dimensional speckle tracking echocardiography in adult patients with surgical repair of tetralogy of Fallot

Background: In patients late after correction of Tetralogy of Fallot (TF) the combined effects of preoperative hypertrophy and hypoxia, possible intraoperative myocardial damage, type of reconstruction, acquired postoperative lesions such as pulmonary or aortic regurgitation, and congenital vasculopathy may result in impaired right ventricular (RV) as well as left ventricular (LV) function. We hypothesized that a comprehensive assessment of ventricular, aortic and pulmonary artery function could help to better understand the pathophysiology of this complex disease. Methods: Eighteen patients (mean age 37 ± 14 years) with repaired TF and eighteen age-matched healthy subjects selected as controls were studied. LV and RV longitudinal, circumferential, and radial strains were calculated by three-dimensional speckle tracking echocardiography (3DSTE). Global area strain (GAS) was obtained by 3DSTE as the percentage variation in the surface area defined by the longitudinal and circumferential strain vectors. Pulmonary artery (PA) and ascending aorta (Ao) stiffness and strain were determined using M-mode and speckle tracking echocardiography. Data analysis was performed offline. Results: Overall, Ao and PA stiffness were increased (p=0.0003) and Ao and PA strains were decreased (p=0.0002) in TF patients compared to controls. Stiffness index had a negative correlation with Ao (p<0.001) and PA (p<0.005) strain. Ao and PA strains correlated with LV and RV longitudinal strain (p<0.05 and p<0.01 respectively) and LV and RV area strain (p=0.02 and p<0.01 respectively). A significant correlation was found between PA stiffness and pulmonary regurgitant fraction and volume (p=0.004), and between Ao stiffness and aortic regurgitant fraction and volume (p<0.001). Conclusions: In patients with repaired TF increased PA and Ao stiffness are associated with reduced RV and LV 3DSTE parameters. Changes in PA and Ao stiffness and strain are more pronounced in the presence of pulmonary or aortic regurgitation and should be taken into account when evaluating post-operative TF

Circumferential deformation of the thoracic aorta in hypertensive patients by three-dimensional speckle tracking echocardiography

Background: Aortic stiffness may be associated with an increased incidence of cardiovascular events and has been reported to be related to arterial wall motion velocities as measured by tissue Doppler imaging (TDI). The aim of this study was to investigate the potential clinical apllication of three-dimensional speckle tracking echocardiography (3DSTE) for the assessment of aortic function parameters in healthy and hypertensive adults. Methods: We examined 95 hypertensive (mean age, 67 ± 14 years; 53% male) and 95 healthy adults (mean age 69 ± 12 years; 51% male). Ascending aorta M-mode, TDI and STE parameters were measured. Aortic distensibility (D) and aortic stiffness index (SI) were calculated using accepted formulae. Global peak circumferential ascending thoracic aorta strain by 3DSTE (3D-AoS) was determined (GE EchoPAC) as an average of multiple segments of arterial wall deformation. The corrected 3D-AoS was calculated as the global 3D-AoS/pulse pressure. Comprehensive echocardiography was performed for the assessment of the LV systolic/diastolic function. Results: Intraobserver variation of 3D-AoS ranged from 3% to 5% and interobserver variation ranged from 4% to 7%. Both D (p<0.05) and 3D-AoS (p<0.001) were significantly lower in hypertensive compared to control subjects. Reduced D and increased SI were consistent with evidence of increased aortic stiffness in both male and female hypertensive patients. SI increased and D decreased with increasing age or systolic blood pressure. Multivariate analysis showed 3D-AoS to be independently related to pulse pressure (p<0.01), LV mass index (p=0.003), and diastolic function (p=0.002). Conclusions: Aortic 3DSTE parameters have higher reproducibility compared to TDI and 2D indices, differentiate hypertensive from healthy adults, and reflect aortic compliance changes related to age and sex and LV diastolic function

Assessment of right ventricular function by tissue Doppler imaging in patients with chronic obstructive pulmonary disease

Background. The evaluation of right ventricular function is clinically useful in patients with chronic obstructive pulmonary disease (COPD because the presence of right ventricular failure has prognostic implications. All invasive and non invasive techniques evaluating right ventricular performance have important limitations due to right ventricular complex geometry. The introduction of Doppler measurement of myocardial wall velocities (tissue Doppler imaging, TDI) and the recently developed strain rate (SR) imaging technique have made possible a more adequate assessment of global and regional systolic and diastolic right ventricular function. Our purpose was: 1) to compare TDI/SR parameters with conventional indices evaluating right ventricular function; 2) to assess the correlation among TDI/SR parameters and respiratory function tests . Methods. Twenty-nine patients (age 5313 years) with chronic obstructive pulmonary disease were included in the study. 15 patients had pulmonary artery pressure >35mmHg (group I), 14 patients had pulmonary artery pressure <35mmHg (group II). Sixteen age- and gender-matched healthy subjects who had normal cardiac findings served as controls (group III). Right ventricular ejection fraction (EF), fractional shortening (FS), and tricuspid flow filling parameters (E/A ratio, DT) were determined. Offline analysis of the myocardial velocity data sets was performed using dedicated software (Aplio, Toshiba Corp.). Velocity and strain traces from right ventricular free wall at 3 levels (basal, mid cavity, and apical) were processed from the same wall site in the apical 4-chamber view. Diastolic TDI values (Ew, Aw), peak systolic strain and systolic and diastolic strain rate values were determined. Echocardiographic parameters were evaluated after the respiratory function tests were performed ( FEV1= forced expiratory volume in one second; FEV1/VC = forced expiratory volume in one second / vital capacity; DLCO = single-breath diffusion capacity of the lung for carbon monoxide; DLCO/VA = carbon monoxide diffusion capacity per unit of alveolar volume ) . Results. Measurements of TDI/SR parameters were rapidly obtained with a low inter- and intra-observer variability. Ew/Aw ratio at apical and mid level was lower in Group I and II than in Group III (p<0.005). Peak systolic strain and systolic and diastolic strain rate at apical and mid level were lower in Group I and II than in Group III (p<0.001). Right ventricular EF, FS, E/A ratio, and DT were not different among the three groups. No correlation was found between EF, FS, E/A ratio, DT, and respiratory function tests. A highly significant relationship was shown between peak systolic strain at mid level and DLCO/VA (r=0.67, p<0.001) and peak systolic strain at mid level and FEV1/VC (r=0.69, p<0.001). Conclusion. Thus in COPD patients TDI/SR parameters can determine right ventricular dysfunction that is not shown by conventional echocardiographic indices and is correlated with respiratory function tests

Early detection of myocardial involvement by strain Doppler echocardiography in patients with acromegaly

Background. A considerable literature suggests that there is a specific cardiomyopathy in acromegaly, resulting in structural and functional abnormalities that may be partially reversed by effective reduction in growth hormone / insulin-like growth factor I (GH/IGF-I) levels. Recent reports suggest that structural changes can occur after short-term exposure to GH. The aim of our study was the early detection of subclinical cardiac involvement in patients with acromegalia using tissue Doppler (TDI) and strain Doppler (SR) imaging. Methods. Thirty-nine patients with acromegalia underwent physical examination, electrocardiogram, and standard transthoracic echocardiogram in order to exclude those with cardiac involvement. The remaining twenty-seven patients without clinical and echocardiographic cardiac involvement (group 1, age 5113 years, 16 females) were compared to 24 sex and age-matched controls (group 2, age 4912 years, 11 females). Left and right ventricular ejection fraction (LVEF, RVEF), fractional shortening (LVFS, RVFS), and mitral and tricuspid flow filling parameters (MV and TV E/A ratio, MV and TV DT) were determined. Offline analysis of the myocardial velocity data sets was performed using dedicated software (Aplio, Toshiba Corp.). Velocity and strain traces from left and right ventricular free wall at 3 levels (basal, mid cavity, and apical) were processed from the same wall site in the apical 4-chamber view. Systolic (Sw) and diastolic (Ew, Aw) wall velocities as well as peak systolic strain () and systolic and diastolic (isovolumic, early and late diastolic) SR values (SR-S, SR-IVR, SR-E, SR-A) were determined. Results. Dimensions of left and right atrial and ventricular chambers were similar between the two groups. No significant differences were determined between the two groups for the following parameters: LVEF, RVEF, LVFS, RVFS, MV and TV E/A ratio, MV and TV DT. A significant difference was found between the two groups for MV and TV Ew/Aw ratio at basal level (p<0.001 and p<0.05, respectively). Left and right ventricular peak systolic and systolic and early diastolic SR values were significantly reduced compared to controls at basal (p<0.001) and mid-cavity level (p<0.005) but not at apical level. Conclusion. In patients with acromegaly TDI/SR parameters (mainly from basal ventricular segments) can show a possible early cardiac involvement not detected by conventional echocardiography

Echocardiographic assessment of ventricular asynchrony in dilated cardiomyopathy and congenital heart disease: Tools and hopes

Ventricular dyssynchrony is a relatively common problem in patients with heart failure, in particular those with wide QRS complex, and appears to have a deleterious effect on the natural history of heart failure, as it has been associated with increased mortality. Mechanistic studies, observational evaluations, and randomized trials have consistently demonstrated the beneficial effects of cardiac resynchronization therapy (CRT) in patients with moderate-to-severe chronic systolic heart failure and ventricular dyssynchrony who have failed optimal medical treatment. However, despite the promising results, it is estimated that in approximately 30% of patients undergoing CRT, the symptoms of heart failure do not improve or become even worse. one of the most important reasons for this failure is probably the lack of distinct mechanical dyssynchrony before implantation. A number of echocardiographic tools have been developed during the past 3 years for quantitative measurement of the severity of dyssynchrony before and after CRT. This review discusses the actual and potential role of different echocardiographic techniques in selection of patients and optimization of CRT and the value of some new clinical applications such as in congenital heart disease